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Satar S, Şahin ME, Ergün P. The effect of comprehensive multidisciplinary pulmonary rehabilitation on 5-year survival in COPD: does maintaining a home exercise program improve survival? Turk J Med Sci 2022; 52:1785-1792. [PMID: 36945992 PMCID: PMC10390114 DOI: 10.55730/1300-0144.5524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is one of the most common causes of death worldwide. Therefore, optimizing medical therapy in the comprehensive management of the disease, as well as including pulmonary rehabilitation (PR) in the treatment, is essential. The goal of our study was to determine the impact of PR on the survival of COPD patients. METHODS Between 2007-2015, 509 COPD patients who completed the PR constituted the PR group, while 167 patients who applied but could not complete it after the initial evaluations formed the control group. In the PR group, dyspnea perception, exercise capacity, muscle strength, body composition, quality of life, psychosocial status, and i-BODE scores were assessed at the beginning and end of the program, whereas in the control group, these assessments could only be conducted at the beginning. Also, after PR, our PR participants have prescribed a home exercise program, and they were recalled to the hospital at the 3rd, 6th, 12th, 18th, and 24th months for follow-up visits. RESULTS A statistically significant improvement was found in almost all the data (except FEV1/FVC, BORG after exercise, and FFMI) after PR. There was a statistically significant difference in 5-year survival in favor of the PR group (p = 0.006), and in PR patients who accompanied the home exercise program vs. those who did not (p = 0.000). Also the gains in MRC (p = 0.003; OR: 2.20; CI: 1.319- 3.682), MEP (p = 0.041; OR: 1.02; CI: 1.001-1.035), and i-BODE (p = 0.006; OR: 0.914; CI: 0.857-0.974) increased the survival. DISCUSSION Apart from incorporating PR into treatment in the comprehensive management of COPD, we demonstrated that maintaining a home exercise program for at least two years following PR increased 5-year survival significantly.
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Affiliation(s)
- Seher Satar
- Department of Chest Diseases, Ankara Atatürk Sanatorium Training and Research Hospital, Health Sciences University, Turkey
| | - Mustafa Engin Şahin
- Department of Chest Diseases, Ankara Atatürk Sanatorium Training and Research Hospital, Health Sciences University, Turkey
| | - Pınar Ergün
- Department of Chest Diseases, Ankara Atatürk Sanatorium Training and Research Hospital, Health Sciences University, Turkey
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2
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Kim HJ, Choi HE, Jang HJ, Kim HK, Park JH, Lee JH, Kim TH. Current status and trends of pulmonary rehabilitation in South Korea: National level data analysis using Health Insurance Review and Assessment Service (HIRA) database from 2016 to 2018. Medicine (Baltimore) 2022; 101:e31085. [PMID: 36254088 PMCID: PMC9575737 DOI: 10.1097/md.0000000000031085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In South Korea, there are few studies to understand the current status of pulmonary rehabilitation in clinical practice and develop it. This study aimed to assess the current status and annual changes in the number and pattern of prescriptions for pulmonary rehabilitation before and after its insurance coverage. The trends of pulmonary rehabilitation before and after its insurance coverage commencement were evaluated using the data of 24,380 patients during the 3-year period from 2016 to 2018 that were archived by the National Health Information Database of the Health Insurance Review and Assessment Service in South Korea. The annual total number of patients who received pulmonary rehabilitation was stratified by the type of prescription, sex, age, type of insurance, medical institution, and region. In addition, the frequencies of pulmonary rehabilitation for various diagnoses were investigated using the major codes of the Korean Standard Classification of Disease. The patients who received pulmonary rehabilitation increased by approximately 2 times from 5936 in 2016 (before insurance coverage) to 10,474 in 2019. Before 2017, most patients underwent simple pulmonary rehabilitation coded as MM290. However, since the insurance coverage of rehabilitation exercise for pulmonary disease (MM440), the proportions of patients receiving them increased. Men underwent pulmonary rehabilitation more often than women, and >70% of the patients were aged >60 years. Most patients received pulmonary rehabilitation at tertiary hospitals in Seoul. In 2016, pulmonary rehabilitation was prescribed more frequently for cerebral infarction; after 2017, it was prescribed more frequently for lung cancer. This study summarized the current status and trends of pulmonary rehabilitation in South Korea before and after National Health Insurance Service coverage, which commenced on January 1, 2017. A significant increase in the number of pulmonary rehabilitations was confirmed after the insurance coverage.
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Affiliation(s)
- Hyo-Jung Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Hee-Eun Choi
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Busan, Korea
- *Correspondence: Hee-Eun Choi, Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, 875, Haeun-daero, Haeundae-gu, Busan, Korea (e-mail: )
| | - Hang-Jea Jang
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Hyun-Kuk Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Jin-Han Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Jae-Ha Lee
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Tae-Hoon Kim
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Busan, Korea
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3
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Intensive Intervention Improves Outcomes for Chronic Obstructive Pulmonary Disease Patients: A Medical Consortium-Based Management. Can Respir J 2022; 2022:6748330. [PMID: 35795169 PMCID: PMC9252689 DOI: 10.1155/2022/6748330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/15/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Strategies involving multidimensional approaches for the treatment of COPD are needed. This study aimed to evaluate the efficiency of medical consortium-based management for COPD. Patients were grouped in accordance with whether the hospitals they went to were under the medical consortium. We enrolled 141 COPD patients in the management group and 147 COPD patients in the control group. There was no predetermined sex and disease severity inclusion or exclusion criteria. Patients in the control group were managed by standard care, while patients in the management group were managed with intensive medical intervention jointly by specialists in the hospital and general practitioners and healthcare workers in community health centers. There was no difference in the basal demographics between the two groups. The basal condition of the management group was worse than that of the control group, demonstrated by a higher CAT score and a lower pulmonary function index. Half-year intensive intervention decreased CAT score from 17.28 to 15.62 and the Barthel ADL index from 73 to 60 in the management group, which was associated with better pulmonary rehabilitation, pursed-lip breathing, oxygen usage, and medicine regularity. The benefits became more obvious after one-year intensive intervention in the management group. There was a difference in mMRC grades and smoking cessation between the two groups. This study shows that a one-year intensive intervention improves the patients' health status and pulmonary function, suggesting that our medical consortium-based management is effective in the treatment of COPD.
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4
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Paris D, Palomba L, Tramice A, Motta L, Fuschillo S, Maniscalco M, Motta A. Identification of biomarkers in COPD by metabolomics of exhaled breath condensate and serum/plasma. Minerva Med 2022; 113:424-435. [PMID: 35191295 DOI: 10.23736/s0026-4806.22.07957-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is the third cause of death worldwide, presenting poor long-term outcomes and chronic disability. COPD is a condition with a wide spectrum of clinical presentations because its pathophysiological determinants relate to tobacco smoke, genetic factors, alteration of several metabolic pathways, and oxidative stress. As a consequence, patients present different phenotypes even with comparable degrees of airflow limitation. Because of the increasing social and economic costs of COPD, a growing attention is currently payed to "omics" techniques for more personalized treatments and patient-tailored rehabilitation programs. In this regard, the systematic investigation of the metabolome (i.e., the whole set of endogenous molecules) in biomatrices, namely metabolomics, has become indispensable for phenotyping respiratory diseases. The metabolomic profiling of biological samples contains the small molecules produced during biological processes and their identification and quantification help in the diagnosis, comprehension of disease outcome and treatment response. Exhaled breath condensate (EBC), plasma and serum are biofluids readily available, with negligible invasiveness, and, therefore, suitable for metabolomics investigations. In this paper, we describe the latest advances on metabolomic profiling of EBC, plasma and serum in COPD patients.
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Affiliation(s)
- Debora Paris
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli, Napoli, Italy
| | - Letizia Palomba
- Department of Biomolecular Sciences, University Carlo Bo, Urbino, Italy
| | - Annabella Tramice
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli, Napoli, Italy
| | - Lorenzo Motta
- Section of Radiology, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Salvatore Fuschillo
- Pulmonary Rehabilitation Division of the Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Benevento, Italy
| | - Mauro Maniscalco
- Pulmonary Rehabilitation Division of the Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Benevento, Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli, Napoli, Italy -
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5
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Li Z, Lou J, Wang C, Zhang H. The acupuncture-related therapy for stable chronic obstructive pulmonary disease: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e28832. [PMID: 35147125 PMCID: PMC8830870 DOI: 10.1097/md.0000000000028832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) has become a huge economic burden. Increasing randomized clinical trials have favored the efficacy of a specified kind of acupuncture-related therapies (ATs) for treating stable COPD. Nonetheless, comparative efficacy of different ATs for stable COPD remains unknown. Thus, the purpose of this network meta-analysis protocol aims to determine the optimal modality of ATs for treating stable COPD. METHODS Six Chinese and English mainstream databases, including PubMed, Cochrane Library, Embase, China Biomedical Literature Database, Chinese National Knowledge Infrastructure, and Wanfang Database, will be systematically retrieved. The time range of the literature search is from the establishment date of each database to July, 2021. The primary outcome measures will be pulmonary function and incidence of acute exacerbations. The secondary outcome measures will consist of 6-minute walking distance, St George's Respiratory Questionnaire, and COPD assessment test. The methodological quality of included studies will be evaluated by Cochrane risk-of-bias tool and the quality of evidence will evaluated through Grading of Recommendations Assessment, Development, and Evaluation instrument. Network meta-analysis will be completed using STATA software. RESULTS A synthesis of current evidence of ATs for stable COPD will be provided in this study. CONCLUSION This study will contribute to synthesizing the evidence regarding the comparative efficacy of different modalities of ATs for stable COPD. Therefore, it will yield decision-making reference to further assist clinicians in determining the optimal modality of ATs in the treatment of stable COPD. STUDY REGISTRATION This protocol was registered in the international prospective register of systematic reviews (PROSPERO) with the registration number CRD42020166649.
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Affiliation(s)
- Zengtu Li
- Department of Tuina, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
| | - Jiali Lou
- Department of Acupuncture and Moxibustion, First People's Hospital of Xiaoshan District, Hangzhou City, China
| | - Chao Wang
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, China
| | - Haijuan Zhang
- The Third Clinical Medical College, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou City, China
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Yohannes AM, Casaburi R, Dryden S S, Hanania NA. Predictors of premature discontinuation and prevalence of dropouts from a pulmonary rehabilitation program in patients with chronic obstructive pulmonary disease. Respir Med 2022; 193:106742. [DOI: 10.1016/j.rmed.2022.106742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 12/30/2022]
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Mao X, Ni Y, Niu Y, Jiang L. The Clinical Value of Pulmonary Rehabilitation in Reducing Postoperative Complications and Mortality of Lung Cancer Resection: A Systematic Review and Meta-Analysis. Front Surg 2021; 8:685485. [PMID: 34646857 PMCID: PMC8503917 DOI: 10.3389/fsurg.2021.685485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Pulmonary rehabilitation is one meaningful way of improving exercise tolerance and pulmonary function. Thus, it may reduce the postoperative complications and mortality of pulmonary resection. Hence, we refreshed the data and conducted this systemic analysis. Method: We searched Pubmed, Web of Science, and EMBASE using “lung OR pulmonary” AND “operation OR resection OR surgery” AND “rehabilitation or exercise.” The cut-off date was September 30, 2020. The publications were filtrated, and data were extracted from all selected studies by two reviewers. Review Manger 5.1 and the fixed or random regression model were used for calculating the pooled odds ratio (OR). Result: Finally, 13 publications were enrolled in this study. Among them, five publications reported mortality, nine reported postoperative complications, and seven reported postoperative pulmonary complications. The pooled OR of mortality was 1.32 [95% confidence interval (CI): 0.54–3.23] for the pulmonary rehabilitation group, the pooled OR of postoperative complications was 0.62 (95% CI: 0.49–0.79) for the pulmonary rehabilitation group, and the pooled OR of postoperative pulmonary complications was 0.39 (95% CI: 0.27–0.56) for the pulmonary rehabilitation group. Subgroup analysis revealed the perioperative pulmonary rehabilitation was the most important part. Conclusion: Pulmonary rehabilitation may not affect the mortality of pulmonary resection patients, however, it could decrease the number of postoperative complications, especially pulmonary complications. Perioperative pulmonary rehabilitation was the most important part of the program.
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Affiliation(s)
- Xiaowei Mao
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, China
| | - Yiqian Ni
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, China
| | - Yanjie Niu
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, China
| | - Liyan Jiang
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, China
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8
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Ufere NN, Donlan J, Indriolo T, Richter J, Thompson R, Jackson V, Volandes A, Chung RT, Traeger L, El-Jawahri A. Burdensome Transitions of Care for Patients with End-Stage Liver Disease and Their Caregivers. Dig Dis Sci 2021; 66:2942-2955. [PMID: 32964286 DOI: 10.1007/s10620-020-06617-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with end-stage liver disease (ESLD) experience frequent readmissions; however, studies focused on patients' and caregivers' perceptions of their transitional care experiences to identify root causes of burdensome transitions of care are lacking. AIM To explore the transitional care experiences of patients with ESLD and their caregivers in order to identify their supportive care needs. METHODS We conducted interviews with 15 patients with ESLD and 14 informal caregivers. We used semi-structured interview guides to explore their experiences since the diagnosis of ESLD including their care transitions. Two raters coded interviews independently (κ = 0.95) using template analysis. RESULTS Participants reported feeling unprepared to manage their informational, psychosocial, and practical care needs as they transitioned from hospital to home after the diagnosis of ESLD. Delay in the timely receipt of supportive care services addressing these care needs resulted in hospital readmissions, emotional distress, caregiver burnout, reduced work capacity, and financial hardship. Participants shared the following resources that they perceived would improve their quality of care: (1) discharge checklist, (2) online resources, (3) mental health support, (4) caregiver support and training, and (5) financial navigation. CONCLUSION Transitional care models that attend to the informational, psychosocial, and practical domains of care are needed to better support patients with ESLD and their caregivers at the time of diagnosis and beyond. Without attending to the multidimensional care needs of newly diagnosed patients with ESLD and their caregivers, they are at risk of burdensome transitions of care, high healthcare utilization, and poor health-related quality of life.
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Affiliation(s)
- Nneka N Ufere
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - John Donlan
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Teresa Indriolo
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - James Richter
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ryan Thompson
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vicki Jackson
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Angelo Volandes
- Section of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Raymond T Chung
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Lara Traeger
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Areej El-Jawahri
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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9
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Fuschillo S, Paris D, Tramice A, Ambrosino P, Palomba L, Maniscalco M, Motta A. Metabolomic profiling of exhaled breath condensate and plasma/serum in chronic obstructive pulmonary disease. Curr Med Chem 2021; 29:2385-2398. [PMID: 34375174 DOI: 10.2174/0929867328666210810122350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is an increasing cause of global morbidity and mortality, with poor long-term outcomes and chronic disability. COPD is a condition with a wide spectrum of clinical presentations, with different phenotypes being identified even among patients with comparable degrees of airflow limitation. Considering the burden of COPD in terms of social and economic costs, in recent years a growing attention has been given to the need of more personalized approaches and patient-tailored rehabilitation programs. In this regard, the systematic analysis of metabolites in biological matrices, namely metabolomics, may become an essential tool in phenotyping diseases. Through the identification and quantification of the small molecules produced during biological processes, metabolomic profiling of biological samples has thus been proposed as an opportunity to identify novel biomarkers of disease outcome and treatment response. Exhaled breath condensate (EBC) and plasma/serum are fluid pools, which can be easily extracted and analyzed. In this review, we discuss the potential clinical applications of the metabolomic profiling of EBC and plasma/serum in COPD.
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Affiliation(s)
- Salvatore Fuschillo
- Institute Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Division of the Telese Terme Institute, 82037 Telese Terme (BN), Italy
| | - Debora Paris
- Institute of Biomolecular Chemistry, National Research Council, 80078 Pozzuoli (NA), Italy
| | - Annabella Tramice
- Institute of Biomolecular Chemistry, National Research Council, 80078 Pozzuoli (NA), Italy
| | - Pasquale Ambrosino
- Institute Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Division of the Telese Terme Institute, 82037 Telese Terme (BN), Italy
| | - Letizia Palomba
- Department of Biomolecular Sciences, University "Carlo Bo", 61029 Urbino, Italy
| | - Mauro Maniscalco
- Institute Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Division of the Telese Terme Institute, 82037 Telese Terme (BN), Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, 80078 Pozzuoli (NA), Italy
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10
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Nnate DA, Barber D, Abaraogu UO. Discharge Plan to Promote Patient Safety and Shared Decision Making by a Multidisciplinary Team of Healthcare Professionals in a Respiratory Unit. NURSING REPORTS 2021; 11:590-599. [PMID: 34968334 PMCID: PMC8608050 DOI: 10.3390/nursrep11030056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) often require frequent hospitalization due to worsening symptoms. Preventing prolonged hospital stays and readmission becomes a challenge for healthcare professionals treating patients with COPD. Although the integration of health and social care supports greater collaboration and enhanced patient care, organizational structure and poor leadership may hinder the implementation of patient-oriented goals. This paper presents a case of a 64-year-old chronic smoker with severe COPD who was to be discharged on long-term oxygen therapy (LTOT). It also highlights the healthcare decisions made to ensure the patient's safety at home and further provides a long-lasting solution to the existing medical and social needs. The goal was accomplished through a discharge plan that reflects multidisciplinary working, efficient leadership, and change management using Havelock's theory. While COPD is characterized by frequent exacerbation and hospital readmission, it was emphasized that most failed discharges could be attributed to bureaucratic organizational workflow which might not be in the patient's best interest. It was further demonstrated that healthcare professionals are likely to miss the window of opportunity to apply innovative and long-lasting solutions to the patient's health condition in an attempt to remedy the immediate symptoms of COPD.
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Affiliation(s)
- Daniel A. Nnate
- Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK;
| | - David Barber
- Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK;
| | - Ukachukwu O. Abaraogu
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK;
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11
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Abstract
Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder with significant morbidity and mortality. Despite its prevalence, COPD is underdiagnosed, and many patients do not receive a diagnosis until the disease is clinically advanced. Recent basic science and clinical research have focused on the early physiologic and pathobiologic changes in COPD with the hopes of improving diagnosis, providing targets for disease-modifying therapy, and identifying patients most likely to benefit from early intervention. Available treatments for COPD have grown substantially in the past 20 years with the introduction of new oral and inhaled medications as well as novel surgical and bronchoscopic procedures. This article summarizes some of the recent advances in our understanding of disease pathogenesis and treatment paradigms.
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Affiliation(s)
- Michael C Ferrera
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA; , ,
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA; , ,
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA; , ,
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12
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Kohlbrenner D, Sievi NA, Senn O, Kohler M, Clarenbach CF. Long-Term Effects of Pedometer-Based Physical Activity Coaching in Severe COPD: A Randomized Controlled Trial. Int J Chron Obstruct Pulmon Dis 2020; 15:2837-2846. [PMID: 33192057 PMCID: PMC7655791 DOI: 10.2147/copd.s279293] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/14/2020] [Indexed: 02/04/2023] Open
Abstract
Background and Objective Limited evidence on long-term effects of physical activity programs in COPD is available. The aim of the study was to investigate the effects of a three-month program combining physical activity counselling and pedometer-based feedback in addition to usual care, followed by a nine-month unsupervised observation period as compared to usual care in participants with severe to very severe COPD. Methods Participants were randomized to either a control group receiving usual care or an intervention group receiving motivational support, an activity diary with an individual step count goal (ie, an increase of ≥15% from baseline) and a pedometer in addition to usual care. The intervention ended after three months and an unsupervised observational period followed until twelve months. Primary outcome was daily step count after one year. Results Seventy-four participants were included, 61 (82%) completed the study. Linear regression modelling, adjusted for baseline step count, showed no significant difference in change in step count after 12 months between the groups (Β = 547.33, 95% CI = −243.55/1338.20). Conclusion A three-month program combining physical activity counselling and pedometer-based feedback in addition to usual care does not attenuate the declining course of physical activity in participants with severe and very severe COPD during a long term follow-up of one year as compared to usual care. This result was primarily determined by the low intervention response rates to the combined program. Clinical Trial Registration www.ClinicalTrials.gov, NCT03114241.
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Affiliation(s)
- Dario Kohlbrenner
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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